2113, poster, cat: 56
PATIENT ADHERENCE TO AHA GUIDELINES PRE- AND POST AMI
University of Maryland, Baltimore, MD, USA
Objective: To assess patient adherence to recommended drug therapy.Background: For patients that suffered from an acute myocardial infarct (AMI), the 2001 guidelines of the American Heart Association (AHA) recommend indefinite treatment with (1) statins, (2) beta-blockers, (3) ace inhibitors or, if not tolerated, angiotensin-receptor blockers, and (4) aspirin. Methods and Results: This retrospective, claims database study was performed using data from a large health insurer in the Mid-Atlantic region. Patients were selected if they had an initial AMI episode (ICD-9 Code: 410.x1) between January 1, 2002 and August 31, 2004 and matched to their pharmacy claims between January 1, 2001 and December 31, 2004. For each patient, adherence is defined as the proportion of days covered. A total of 1,958 patients were identified. Requiring at least 6 months (1 year, 2 years) of follow-up data post discharge adherence rates with recommended therapy are as follows: statins: 42% (40%, 35%); beta-blockers: 43% (41%, 35%); ace-inhibitors or ARB’s: 35% (33%, 29%). Overall, 13% of patients can be defined as adherent to the AHA recommendations, whereas 19% of patients have filled zero of the recommended prescriptions. Notably, 12%-15% of patients were receiving at least one of the drugs even before the AMI. In this subgroup adherence rates decrease after the AMI by: statins: 20%; beta-blockers: 22%; ace-inhibitors or ARB’s: 30%.Conclusion: The AHA post-AMI treatment recommendations are followed only by a minority of patients. In addition, mean adherence rates drop after the AMI if the patient was receiving prophylactic therapy.